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ACCREDO HEALTH GROUP, INC.
DSH390027 TEMPLE UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
TEMPLE UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390027
Entity Address
3401 North Broad Street
PHILADELPHIA, PA 19140
Medicare Provider Number
390027
Participating Start Date
1/1/2004
Last Recertification Date
8/17/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
4/9/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Abhinav Rastogi, President & C.E.O
(215) 707-4299
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
4/9/2023
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